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State of the art in Robotic Surgery in Ponderas Academic Hospital.

Maura-Elena Buza
Destination Spotlight

In Romania, at Ponderas Academic Hospital, there is the first and only Center of Excellence in Robotic Surgery in Romania. The team consisting of 8 surgeons with different specialties has operated robotically on more than 1,300 patients, during the more than 5 years of operation.

The daVinci Xi surgical robot is a high-performance computer that assists the surgeon in performing surgeries, with the physician operating the robotic arms from a console just a few meters away from the patient, closely controlling every movement of the robotic arms. An extensive medical team is present in robotic surgeries, as it is in classic interventions. The daVinci Xi robot, the most advanced robotic surgery system in the world

The robot improves the technical skills, dexterity and visibility of the surgeon in the operating field and thus increases the precision of the surgical intervention, thus offering the patient a customized treatment adapted to their needs. The team of specialized robotic surgeons of Ponderas Academic Hospital operates on a wide range of complex conditions, such as oncology surgery, digestive surgery, urology, gynecology, thoracic surgery and hernia surgery.

"At Ponderas Academic Hospital, daVinci Xi allows addressing different specialties. This is the standard of surgery. Not in the future, but today. Because minimally invasive means better, less complications and better recovery for the patient." – Prof. Dr. Catalin Copaescu, Coordinator of the Robotic Surgery Center of Ponderas Academic Hospital.

From a technical point of view, the daVinci robot is a high-performance system, with 3 robotic arms that can rotate in 7 directions, 540 degrees. They are handled, from the console located just a few meters away from the patient, by the surgeon who acquires, with the help of the console that mimics the movements of the surgeon's hand, a freedom of movement and a precision superior to the human hand. The fourth arm has a 3D video camera that guides the surgeon during the procedure and provides a 3D view, magnified approximately 10 times.

"It must be said from the beginning that we are not talking about a robotization of the surgical act, but the fact that between the surgeon and the patient is a high-performance computer, which allows a much finer surgery, with additional attention to details, with the disappearance of tremors, with tools that have 7 degrees of freedom, which make access in narrow spaces possible" – Dr. Victor Tomulescu, Surgeon of Excellence in Colorectal Surgery

Magnified view and freedom of movement mean, for the patient, greater certainty about the outcome of the intervention they are undergoing: fine, precise cuts that allow the total excision of the tissues to be removed and the preservation of all fine nerve structures, which help the patient to recover faster and easier, facts that would not have been possible in classic, open surgery. The incisions made during robotic interventions are sometimes only a few millimeters long, while open surgeries involve incisions, stitches and implicitly a scar, even of 15 or 20 centimeters.

Who are robotic interventions for?

The use of medical robots is enjoying increased interest in multiple surgical specialties. Gradually, the robotic approach became the first indication in the treatment of certain pathologies.

In general surgery, the most common pathology treated robotically at Ponderas Academic Hospital is colorectal cancer.

Dr. Victor Tomulescu, Surgeon of Excellence in Colorectal Surgery, says that "the special advantages are related to pelvic dissection with nerve preservation, especially for large rectal tumors in male patients, the rate of postoperative sexual and urinary dysfunctions being greatly reduced. The surgeon experienced in colorectal surgery sees the true value of the robotic system in cases of increased difficulty, where the three-dimensional image of unmatched quality and the fine instruments with 7 degrees of freedom make the difference".

Dr. Bogdan Smeu, primary general surgery physician specialized in robotic surgery, robotically operates on complex hernias, eventrations and abdominal pathologies. "Robotic surgery has increased the coverage of minimally invasive interventions that could not have been performed with the same accuracy without a robot. We feel the benefits of robotic surgery both during the surgery, through the precision of the surgical gestures, which make us surgeons better, and after the surgery, through the quick recovery of the patient. The robot is an intermediate computer that enhances the quality of the surgeon, the one who handles it, because they don’t operate alone. Da Vinci performs the gestures and procedures dictated by the surgeon, thus benefiting from their experience. We’re actually a team!"

At Ponderas Academic Hospital there is a wide range of conditions, both benign and malignant, that can be treated robotically:

· Urological conditions (prostate tumors, kidney and bladder tumors)

· Digestive conditions (hepatic, pancreatic, colorectal conditions)

· Thoracic conditions (mediastinal, thymic, pulmonary tumors)

· Gynecological conditions (uterine fibromatosis, ovarian and cervical tumors)

· Abdominal wall defects (complex hernias, eventrations)

Thus, following such a diagnosis, a checkup with a surgeon who operates robotically is recommended, to establish together with them whether the robotic approach is recommended and appropriate in the case of the pathology the patient suffers from.

The benefits of robotic surgery for the patient

For the patient, the finesse with which the robot helps the surgeon to operate means a low risk of postoperative complications, minimal bleeding, quicker and easier recovery, thanks to both the increased precision and incisions of only a few millimeters long, sometimes due to the miniature instruments used by robotic arms.

Dr. Andrei Nadu, urologist specialized in robotic surgery, says that "the body is reactive and the more we intervene on it, with bigger incisions, with bigger instruments, the more the body will fight to recover, so the patient will feel weaker after the intervention. With the help of the daVinci robot, the incisions are often millimeters long, and the postoperative pain is minimal, the recovery is very quick, the patient resumes their usual life the very next day after the intervention".

If a classic surgery requires a prolonged period of hospitalization, of at least 1 week, minimally invasive surgery offers the advantage of a reduced hospitalization, of only 24 hours in case of certain pathologies.

Cristina was operated on for a thoracic tumor and she says that it seemed to her "something like SF to get operated by a robot, but I wanted to have every chance of success from the beginning. I was hospitalized for 3 days, of which 24 hours in the ICU, but already since the next day I was on my feet, laughing, eating. The recovery period was quite short, since the fourth day the pain was bearable and I no longer needed to take pills. A week after the surgery I was already slowly starting to resume all my activities around the house, and after a month I was able to resume my gardening activities. The scars are very small, I've already forgotten about them, pain is no longer a problem."

"One of the great advantages of robotic surgery is the finesse with which one can perform dissections in narrow spaces, which are difficult to approach and having sensitive structures. The extremely clear, 10x magnification and 3D in-depth view of anatomical structures, as well as the extremely precise gestures that allow millimeter dissection, without damaging vital structures that the daVinci robot offers, make possible the complete resection of tumors, in conditions of maximum safety and minimum invasion", says Dr. Felix Dobritoiu, specialist thoracic surgeon specialized in robotic surgery.

In other words, when robotic surgery represents a solution for the patient's pathology, it is possible to preserve the organ affected by the tumor, by removing the tumor mass, with oncological safety limits, which allow the patient to get rid of the tumor, whether malignant or benign, to minimize the chances of recurrence, through the precision and finesse of excision of the tumor boundaries and preserve a healthy organ, which will help them quickly resume their usual activities.

George was diagnosed with kidney cancer at the age of 48. "I accepted from the beginning the surgical option proposed by the doctor, i.e. the robotic intervention, because I understood exactly what major benefits it has for my case and that it was the only solution for me to preserve my kidney." says George.

Due to the precision of the miniature surgical instruments used by the robotic arms, nerves and blood vessels, which are very fine and delicate structures, cannot only be visualized very well, but their damage can also be avoided, which means not only a quick and easy recovery for the patient, but also a high quality of life without post-operative complications. For example, in case of a diagnosis of prostate cancer, Dr. Dan Diaconescu, primary urologist, says that "prostate cancer therapy involves radical prostatectomy. The intervention requires the total removal of the prostate along with the seminal vesicles, with full preservation of the urinary sphincter and the nerves that control urinary continence and potency. Because at this level there are small and very fine anatomical and nervous structures, which have an essential role for the patient's quality of life, the gold standard of the intervention is robotic surgery".

The experience of surgeons who operate robotically at Ponderas Academic Hospital is internationally recognized

Ponderas Academic Hospital was designated Center of Excellence in Robotic Surgery by the Surgical Review Corporation (SRC), it being the first Robotic Surgery Center with international recognition in Romania.

The accreditation by the Surgical Review Corporation came as a recognition of the results and experience of the medical team, following a rigorous assessment of all operated cases, from the perspective of the number of interventions, the surgical technique used, the small number of postoperative complications, the short period of hospitalization and the results obtained, as well as the protocols and circuits specifically dedicated to robotic surgery. The multidisciplinary team consisting of 8 robotically accredited physicians with extensive experience in laparoscopic surgery is coordinated by Prof. Dr. Catalin Copaescu, Surgeon of Excellence in Robotic Surgery.

Prof. Dr. Catalin Copaescu, the medical director of Ponderas Academic Hospital, is one of the founders of the first integrated minimally invasive and robotic surgery program in Romania, a program in which physicians learn to work with new technologies.

Based on his long experience, he received the accreditation for Surgeon of Excellence in Robotic Surgery and he is the coordinator of the Robotic Surgery department of Ponderas Academic Hospital.

Ponderas Academic Hospital is in Bucharest and is an integrated diagnostic and treatment center and has 9 international accreditations from both European and American societies, also being the first and only multidisciplinary hospital in Romania accredited by Joint Commission International for the safety and quality of the medical act. With an experienced medical team, Ponderas Academic Hospital is offering medical programs for prevention, complete evaluation, therapeutic planning, all types of surgeries for all pathologies followed by appropriate postoperative treatment and long-term follow-up. Here you will find all medical and surgical specialties in a single hospital, both inpatient and outpatient services completed by the emergency room and imaging department.

Ponderas Academic Hospital is part of REGINA MARIA private healthcare network, and it is located in Bucharest, Romania.

REGINA MARIA is the leader of medical quality in Romania and one of the most appreciated medical providers in Europe, with 16 international accreditations for the quality and safety of services, a digitalized patient route and the strongest adoption rate in the country in terms of digital tools and the use of artificial intelligence in medicine

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